When do I need to remove a lipoma?

Written by: Mr James Kirkby-Bott
Published: | Updated: 16/05/2019
Edited by: Lisa Heffernan

A lipoma is a benign fatty lump. Lipomas can occur anywhere the body stores a layer of fatty tissue. Most are found beneath the skin and in front of the underlying layer of muscle, occasionally they can occur between muscles. It’s very rare for a lipoma to be cancerous. When they are cancerous, we call them sarcomas. Mr James Kirkby-Bott tells us a little bit about what causes lipomas and if we need to have them removed.

Are lipomas painful?

Most lipomas are not painful, however, some lipomas can feel tender like a bruise, but it depends entirely on the mix of cells that are within the lipoma. Those that feel tender are called angiolipomas.

The type of lipoma can only be distinguished by looking at the cells under a microscope and not with imaging techniques. Angiolipomas tend to occur as part of an inherited or genetic syndrome, usually on the limbs.

 

What causes a lipoma?

Most lipomas occur by chance and can depend on your particular genes and how they have interacted with your environment. There are some rare genetic syndromes that cause multiple small lipomas, usually on the limbs and torso. These syndromes run in families and mostly affect men in the families affected. They are passed down in an autosomal dominant manner, which means that the offspring of a person with the condition will have a 50% chance of having the gene and having the gene can cause multiple lipomas.

One of these syndromes is called Dercum's disease. This causes angiolipomas, which can be sore when touched. The other syndrome is called multiple lipomatosis syndrome, which usually doesn’t cause angiolipomas, so it is not a painful condition.

Multiple endocrine neoplasia syndromes: type 1, 2a and 2b also have an increased incidence of lipoma type lumps. They tend not to cause symptoms and are generally found when performing scans for other conditions.

When would a lipoma need to be removed?

Most lipomas are removed for cosmetic reasons or because they cause slight discomfort, so in most cases, they do not qualify for NHS funding to be removed and have to be removed privately.

Some lipomas can become quite large and if they are more than 5cm in size or have other suspicious features, they should be evaluated to ensure they are benign. This is done with an ultrasound scan initially and sometimes with an MRI. If reports come back with suspicious findings, then a core biopsy is performed under local anaesthetic. After the biopsy, a diagnosis will be made, but most doctors will remove a lipoma that is quite large to prevent them from growing any bigger.

Angiolipomas that cause discomfort can be removed, but if you are a patient with Dercum's disease, it’s best to have tender lumps removed in batches every 18-24 months. Removing more than six lipomas in any one go is not advised, as this can cause a lot of post-operative pain.

 

How is a lipoma removed?

Smaller lipomas are removed under local anaesthetic as a routine procedure. Larger lipomas require a general anaesthetic, but can also be done as a day case. Everyone will experience bruising and will have a scar after the operation.

Risks are low and complications are uncommon. However, like with any operation, there are always some risks such as recurrence or infection. It is uncommon, but occasionally fluid can fill the space where the lipoma was removed, forming a lump called a seroma. The bigger the space after removing the lipoma the more likely you are to develop a seroma.

As the wound heals up, the risk of developing a seroma decreases and any fluid collected is reabsorbed. Seromas can be troublesome when they occur. It is tempting to drain them, but if repeatedly drained, can lead to infection or a cyst wall developing that then needs removing later.

 

As we’ve seen, most lipomas are benign and removed solely for aesthetic reasons. However, if you have a lipoma that is quite large and causing you some discomfort, it’s better to have it looked at by a specialist like Mr James Kirkby-Bott.

By Mr James Kirkby-Bott
Surgery

Mr James Kirkby-Bott is a consultant general surgeon based in Southampton. He specialises in endocrine surgery and is an expert in the management of endocrine diseases, hernias and gallbladder problems. He also set up one of the UK's leading acute surgery and trauma units in Southampton.

Mr Kirkby-Bott qualified at St George's Medical School and went on to train as an endocrine surgeon at the Hammersmith Hospital in London and was the International Endocrine Fellow in Lille, France where he spent 12 months carrying out research and operating alongside leading specialists. When awarded his Fellowship of the European Board of Surgery in Endocrine surgery he was one of just four surgeons in the UK to be awarded this. Mr Kirkby-Bott founded the Wessex Endocrine Society, a charity providing patient centred training and education in surgical endocrinology across Wessex.

Mr Kirkby-Bott is a Q member and specialist in Quality Improvement (QI) having been involved in numerous QI projects and regional lead for the Emergency Laparotomy Collaborative (2015-2017) and The Wessex Emergency Surgery Network (2017-present). He is currently Consulting for the Academic Health Science Networks emergency laparotomy project. In 2018 he was appointed to a senior role in University Hospital Southampton as co-director for clinical outcomes.

Other awards to his name include the Norman Tanner Prize medal, given by the Royal Society of Medicine in 2008 and Braun Aesclepius prize in endocrine surgery awarded in 2011. Mr Kirkby-Bott is equally committed to his research and has several scientific papers on the role of vitamin D in parathyroid surgery, as well as several book chapters and the first textbook dedicated to Parathyroid disease, to his name.

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